Membership Renewal Form

Submitted by Webmaster on Mon, 23/01/2006 - 20:14.
in

To:
Cairns Community Broadcasters Inc.
Raintrees Shopping Centre
PO Box 891 Manunda Qld 4870
Cairns Australia

Ph. (07) 4053 6891
Fax. (07) 4053 2085
Email: secretary at cairnsfm891.org

Membership Renewal form

Note: items marked * are required. Use n/a for not applicable.

Surname:  *
Given names:  *
Address:  *
City/suburb, State, Postcode:  *
Country: 
Home phone:  *
Work phone:  *
Fax home/work:  *
Mobile:  *
E-mail addess:  *
Date of birth:  dd/mm/yy (optional)

I understand that, as a presenter, I must abide by the Community Radio Code of Practice, and sign and abide by the station's Statement of Commitment.

Tick to sign. *

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(digital signature attached to e-mail address)

Annual Membership fees from July 1 (incl. GST) are: $20 (full), $10 (conc.)

After submitting this form you will be taken to the Payments page. Please give your full name as the payment reference.